Prognostic value of interim and restaging PET/CT in Hodgkin lymphoma. Results of the CHEAP (Chemotherapy Effectiveness Assessment by PET/CT) study – long term observation

Abstract

Very few studies have determined the prognostic value of interim and restaging PET/CT in patients with Hodgkin lymphoma using current standard of care therapy outside clinical trials. We analyzed the effect of the results of interim and restaging PET/CT on the survival (overall- and relapse-free) in patients who received standard first-line treatment based on the stage of disease and risk factors. We investigated the differences between the relapse and non-relapse groups based on the clinical pathological characteristics of patients who had positive interim PET/CT results.Between January 1, 2007 and December 31, 2011, the staging, interim and restaging PET/CT scans of patients with Hodgkin lymphoma were analyzed. The Deauville criteria were used for the evaluation of interim PET/CT scans. One hundred and thirteen Hodgkin lymphoma patients underwent staging, interim and restaging PET/CT scans. None of the therapy was modified based on the interim PET/CT results. The median follow-up time was 43.5 months. A total of 62 early stage patients and 51 advanced stage patients were identified. The five-year overall survival rates were 93.4% in the interim PET negative group and 58% in the interim PET positive group (p<0.001). The five-year relapse-free survival rates for the negative and positive groups were 92.7% and 40.8%, respectively (p<0.001). The negative predictive value was 100% in the early stage group and 82.35% in the advanced stage group. By comparison, the positive predictive values were 53.8% and 58.8%, respectively, in these two groups. In the interim PET positive group, patients over 40 years of age had a significantly higher probability of relapse (p=0.057).The routine clinical use of interim PET/CT is highly recommended based on our investigation. However, patients with positive interim PET/CT results required frequent additional evaluations.

Personalized Management Approaches in Lymphoma

“…4 A positive mid-treatment PET/CT is associated with decreased PFS and OS. 5 However, positive predictive value of interim PET/CT is markedly lower than the negative predictive value (53.8% vs 100%, respectively). 5 Perhaps most exciting over the last decade, however, has been investigation into the role of PET/CT in driving management decisions for HL.…”

“…5 However, positive predictive value of interim PET/CT is markedly lower than the negative predictive value (53.8% vs 100%, respectively). 5 Perhaps most exciting over the last decade, however, has been investigation into the role of PET/CT in driving management decisions for HL. Active exploration seeks to address whether chemotherapy should be de-escalated based on negative interim scans or intensified in response to positive interim scans.…”

Új lehetőségek a refrakter és relabált Hodgkin-lymphomás betegek kezelésében

“…Ebben szerepe lehet a PET/CT vizsgálatok elterjedésének, amely nemcsak a staging során segít a pontosabb stádi-ummeghatározásban, hanem a kezelésre történő reagá-lás lemérésére is alkalmas. Amennyiben az első vonalbeli kezelés közben, illetve a kezelés befejezését követően elvégzett vizsgálat negatív, úgy a beteg hosszú távú esé-lyei jók, relapsus ritkán, kevesebb mint a betegek 10%-ában alakul ki [10]. A vizsgálat pozitív prediktív értéke azonban nem elég nagy, így pozitív eredmény esetén a betegek szoros követése, szükség esetén ismételt biopszia, illetve különböző biológiai prognosztikai markerek (lymphocyta/monocyta arány, thymus and activation-regulated chemokine [TARC]) segít(het) az esetleges relapsus korai felismerésében és kezelésében.…”

Focal colorectal uptake in 18FDG-PET/CT: maximum standard uptake value as a trigger in a semi-automated screening setting

“…The maximum standard uptake value (SUV max ) is currently the most promising candidate to trigger further diagnosis and therapy as it reflects tumour vitality. Thus, the SUV is used to refine chemo- and radiation therapy according to vitality—the rationale behind interim staging with PET/CT [ 7 , 8 ].…”